Smoking: leading by example?

1]. The latter appears to be the central issue raised by P. Degens and R. Merget with regard to the article [1]. The authors state that it is not necessary to move on with the European project as updated equation references already exist [2]. This is where we are compelled to disagree. Apart from the fact that the Swiss Cohort Study on Air Pollution and Lung Diseases in Adults (SAPALDIA) was cited along with many others in table 1 of the article [1], we are not convinced that a study conceived to derive only simple spirometric parameters, in a limited central European area and over a modest lifespan, could qualify as a comprehensive set of references for a continent. While it is important to appreciate the scientific level of the SAPALDIA, which meets standard methodological, epidemiological and statistical criteria , we believe that the new European references should include not only spirometry but also lung volumes, diffusing lung capacity for carbon monoxide and perhaps other tests, all possibly derived from the same subjects; it should cover most of the countries, and expand the lifespan as much as possible owing to the continuous ageing forecast. With this in mind, and in the same way as many other national studies conducted in Europe over recent years that are listed in American Thoracic Society/European Respiratory Society document, the Swiss Cohort Study on Air Pollution and Lung Diseases in Adults reinforces the need for periodically updating the reference values. While waiting for the possibility to perform a new pan-European study, perhaps through a pool of private and public grants, the availability of the Swiss Cohort Study on Air Pollution and Lung Diseases in Adults reference values will certainly be of great help for the Swiss pulmonary function test laboratories. Lung function in healthy never smoking adults: reference values and lower limits of normal of a Swiss population. ''Smoking kills'', ''Smoking seriously harms the health of you and others around you'' and ''Smoking clogs the arteries and causes heart attacks and strokes'' are among the statements now seen frequently on the packaging of tobacco products in the UK, such statements having become a legal requirement in 2003. Following a recent UK directive, cigarette packages will carry picture warnings by the end of 2008 [1]. No one can argue that smoking is not bad for health. The effects on health of smoking remain a topical issue …